Project ACTS II: Increasing Donor Registration among African Americans Abstract The proposed project brings together a multidisciplinary team with expertise in the behavioral sciences, epidemiology, ethnic/racial minority health, and transplantation to evaluate the effectiveness of a culturally- sensitive intervention (Project ACTS: About Choices in Transplantation and Sharing) designed to increase registration on the Georgia state donor registry in metropolitan Atlanta areas that have the highest percentages of African Americans (AAs) and the lowest percentage of state donor registrants. Almost 10 years ago, Project ACTS (a DVD and educational booklet) was developed to address many of the well-known barriers to donation among AAs. It was originally developed based on a deep structure model of cultural sensitivity (Resnicow et al., 1999) by virtue of its emphasis on encouraging family discussion of donation intentions and its focus on addressing religious myths. However, Georgia legislation has since changed to allow for the legal expression of donation wishes (even in the face of family objection) through registration on the state donor registry. Subsequently, Project ACTS II was modified to deemphasize family discussion and include wider representation of experiences in donation/transplantation with demonstrated efficacy among community- recruited AA adults. While the preliminary evidence evaluating Project ACTS II is encouraging, the central question about its ability to increase public commitment to donation remains unanswered: To what extent is Project ACTS II effective at increasing registration on the state donor registry in areas that have the highest percentage of AAs and the lowest percentage of donor registration? Using the IIFF Model of Donor Registration (Immediate and complete registration opportunity, Information, Focused engagement, and Favorable action; Siegal et al., 2010), the proposed project will engage 16 community health workers in the implementation of Project ACTS II in targeted metro-Atlanta areas in order to reach 4,000 community members. The specific aims are as follows: Aim 1: To determine the 32 ZIP codes in a 5-county metro-Atlanta area with both the highest percentage of AAs and the lowest percentage of registrants on the state donor registry; Aim 2: To deliver Project ACTS II at 25 discussion sessions in each of 16 ZIP codes identified in Aim 1; Aim 3: To conduct a process and outcome evaluation of Project ACTS II. H1: Individuals attending Project ACTS II sessions will demonstrate significantly improved donation-related knowledge, more favorable attitudes and beliefs towards organ and tissue donation, and increased likelihood to register on the state donor registry from baseline to immediate follow-up. H2: ZIP codes in which Project ACTS II sessions are being conducted will demonstrate a significant increase in donor registrations as compared to control ZIP codes in which Project ACTS II sessions are not being conducted.